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MEASURE THE SEVERITY & IMPACT OF URINARY INCONTINENCE WITH THIS TOOL

Add this to your intake process to spot hidden urinary incontinence problems.

Any patient can experience urinary incontinence, especially if he or she is immobile,smokes, has diabetes, or pelvic muscle weakness. Use this inventory form to gauge how incontinence is affecting your patients and create a plan of care that best suits them.

URINARY INCONTINENCE DISTRESS QUESTIONNAIRE

Answer each question by checking the best response. Fill the form out as completely as possible, taking care to consider patients' symptoms over the last 3 months.

URINARY INCONTINENCE IMPACT QUESTIONNAIRE

The questions below refer to activities of daily life that may be influenced or changed by incontinence. For  ach question, circle the response that best describes how much activities,relationships, and feelings are being affected by urine leakage.

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